The Black Hole: Trauma and Addiction

It has long been understood in the vernacular of the addictions field that those whose “lives become unmanageable” through excessive use of drugs and alcohol may be trying to “drown their pain.” While initially, addicts may feel they have found a way to manage a pain-filled inner world, this synthetic form of mood management can and often does lead to addiction.

For the child who feels unable to bring order to chaos, growing up in a home or living with addiction or other forms of mental illness can be traumatic. Chronic tension, confusion and unpredictable behavior, as well as physical and sexual abuse are typical of addictive environments and can create trauma symptoms. Feelings of fear, frustration, shame, inadequacy, guilt, resentment, self-pity and anger mount, along with rigid defense systems.

HOW GROWING UP WITH ABUSE AND ADDICTION AFFECTS DEVELOPMENT

Development in the young child is a continuous interaction between the child and their primary caretakers. The hardwiring of the child’s brain is set up through countless, tiny interactions. The manner in which the child is treated affects who the child becomes and the ever-growing and changing child in turn affects the caretaker’s response. This synergy creates a fluid rather than static picture of development (Schore 1994). Imagine then how addiction and trauma affect each aspect of the child’s developing personality. Factors that influence a child’s response to a traumatizing family environment are 1) the child’s stage of development 2) the child’s organic structure and 3) the available support network of the child. Young children are particularly vulnerable to developmental deficits as their personalities are yet relatively unformed and there primary support network is the family, which, in the case of abuse and addiction, is causing them damage. They may be forced to contort their personalities in a variety of ways to maintain a sense of connection and some semblance of stability. They live in two worlds: sober/using. In addicted or abusive families there is a front-stage that appears to the world and a backstage that often remains hidden and the rules, morals, thinking, feeling and behavior are often different for both. At times the family dysfunction may surface through a symptomatic child and, if this is the case, a target child or a “symptom carrier” may be created. This designation may effect the child’s personality and his/her developing identity may wrap itself around a negative core. Undoing this in adult patients is a process of peeling back the layers of the onion — undoing distortions of thinking, feeling and behavior one layer at a time as they present themselves for healing. It is difficult for the underage child trapped in this system to get help if the adults do not do so either first or at the same time. If the adults get help, the child’s symptoms may clear up. The older the child gets, the more imbedded their personality issues become and the more these problems invade the overall organization of their identity.

THE EFFECT OF TRAUMA ON FAMILY ORGANIZATION

A family that is containing trauma in the form of addiction or abuse produces relationship dynamics that perpetuate relationship trauma. According to Steven Krugman, the impact of trauma on the family system has three main components. First is constriction leading to enmeshment; second is avoidance leading to disengagement and third is impulsive behavior leading to chaos.

Constriction of emotional and psychological expression can make the authentic expression of pain feel threatening. Family members learn not to talk about what’s going on right in front of them. They learn to hold on to painful emotion that could “rock the boat.” In avoidance, family members see the solution to keeping pain from their inner worlds from erupting as avoiding subjects, people, places and things that might trigger it. This leads to an emotional disengagement among family members. With impulsive behavior that leads to chaos, that inner world is surfacing in action. Painful feelings that are too hard to sit with explode into the container of the family and get acted out in dysfunctional ways that engender chaos.

Constriction, avoidance and impulsive behavior are dysfunctional attempts at dealing with pain. This family becomes fertile ground for producing trauma-related symptoms in its members. In addition, it’s strict taboos against genuine and authentic expression of the emotional pain and psychological angst that family abuse is engendering assure that pain does not get talked about. Consequently, it does not get processed, worked through and put into any context that might allow family members to move through it. Rather, it sits within the family system, a buried land mine waiting to explode when it gets stepped on.

It is no wonder that families such as these produce a range of symptoms in its members that can lead to problems later in life. This is how the mantle of dysfunction gets passed down through the generations. The following are some of the symptoms that may develop and be carried into adulthood:

1. Learned helplessness

2. Hypervigilance

3. Depression

4. Anxiety

5. Numbness

6. Traumatic Bonds

7. Loss of ability to take in support

8. Cycles of reenactment

9. Loss of ability to modulate emotions

10. Emotional triggering

11. Loss of trust and faith

12. Survival guilt

13. High-risk behaviors

14. Fused feelings

15. Development of rigid psychological defenses

16. Desire to self-medicate (Dayton, 2000)

TREATMENT IMPLICATIONS

In my clinical work, I observe that PTSD symptoms in children who grew up with addiction and dysfunction can appear to lie dormant for many years.

Oftentimes, clients arrive at my office in their mid-thirties quite discouraged wondering why their relationships aren’t working or they cannot seem to organize themselves into a productive work life. The traumatic memories are often getting re-stimulated when clients again attempt to enter intimate relationships where the very attempt at deep connection brings up the trauma that previously surrounded it.

Trauma survivors may experience a sense of a foreshortened future having trouble envisioning, and as a result taking steps towards, a future they wish to create. In children who grew up in traumatizing/addicted families this is particularly cruel because the trauma robs them not only of part of their childhood but of significant pieces of their young adulthood as well. The energy they need to “get their lives together” has been partly spent and their youthful dreams and hopes have undergone disillusionment. It is sad that because of this loyalty bind and the developmental timing of the problem there can be significant life complications during young adult years.

TRAUMATIC MEMORY

Because of the way our brain stores them, traumatic memories do not get “thought about” reflected upon and put into some sort of context. The defenses that get engaged during situations of threat are fight,flight and freeze; all of which are associated with the amygdala or the “old” part of the brain. The cortex, which is where thinking, reasoning and long range planning take place, was developed later in human evolution. That’s why when we’re “scared stiff” or “struck dumb” the content of the experience that would normally get thought through and placed into memory storage gets more or less flash frozen instead.

Because these memories are stored in the cells of the body (Pert 1997) as well as the mind, these unintegrated memories may resurface in the form of somatic disturbances such as headaches, back problems, and queasiness or as psychological and emotional symptoms such as flashbacks, anxiety, sudden outbursts of anger, rage or intrusive memories. The person experiencing this may find him or herself in an intense bind in which traumatic memory stimulates disturbing physiological sensations AND disturbing body sensations stimulate traumatic memory. This can create a sort of black hole, an internal combustion that can send a client into an ever-intensifying downward spiral that becomes fraught with fear and anxiety. Clients may experience this as panic, feeling “stuck” in treatment, intense fear or being flooded with feelings and/or memories.

A MIND-BODY APPROACH TO TREATMENT

Traumatic memories are often somatized, repressed, disassociated or lost to consciousness through some form of defensive exclusion (Bowlby 1973).

Because the cortex was not fully involved in the storage of traumatic memories, those experiences did not get thought about and put into a logical context and sequence. Consequently, they can be difficult to access through reflective talking alone. J. L. Moreno, the Viennese psychiatrist who created the method of psychodrama postulated that, “the body remembers what the mind forgets.” Willheim Reich felt that we store our “character defenses” in the tissues of our bodies, and Candie Pert’s pioneering research on cellular memory supports this. Sigmund Freud understood that if we cannot “remember” we are destined to act out or repeat the unconscious content of traumatic experience. It is remembering that allows for a change of pattern. Without it we are blind to our inner world, but that inner world presses nonetheless for action and resolution. Through psychodramatic role-play, long forgotten thinking, feeling and behavior that are attached to roles we’ve played emerge. Words are spoken, feelings are felt and thoughts become present and accessible in the here and now. After they are in their concrete form they can then be reflected upon, understood, deconstructed and meaning can be made out of them. The new narrative will ideally stretch from before the trauma took hold to the present day (Herman, 1992) thus recontextualizing forgotten or split of memory. In this way psychodrama helps clients to put forgotten pieces of their lives back into context to get a fuller picture of who they are.

The group we speak of here is getting help and healing and when they do so they will pass it on to their children. It is the group that is not getting help that will pass along their unresolved pain perhaps by becoming addicts themselves or through a variety of other systemic problems that a root system of trauma and addiction will continue to shoot out. In the managed care world psychodrama and group psychotherapy, along side a model that includes one-to-one therapy and twelve-step programs, represent cost-effective treatment alternatives for issues related to PTSD and addiction.